Saturday, 14 February 2015

The good news: An incompetent Ontario abortion provider, Dr Michel Prevost, was compelled to resign after documentation of poor practices.

The details (we'll get to the bad news in a minute): Because Health Canada is about 30 years behind the rest of the world in approving the "gold standard" of medical abortion, mifepristone, or RU486, doctors are forced to use the less effective protocol of combined methotrexate and misoprostol.

Methotrexate is used not just for abortion but also for the treatment of cancer and autoimmune diseases.

Methotrexate is given by injection the amount of which is individually calculated by each woman’s weight and height. As the medication takes effect, MTX interferes with folic acid and stops fetal cell duplication, and disrupts pregnancy at the stage of implantation in the uterine wall. When given early in pregnancy, it is effective in ending the pregnancy. (If a pregnancy were to continue after taking this drug, the fetus has a high risk of deformities.)

"He displayed a lack of judgment and patients were exposed to harm or injury in his failure to properly screen patients for medical terminations, in his failure to calculate doses of methotrexate on the basis of his patients' respective body surface areas, and in his failure to follow up with patients, including when he was aware that patients had ongoing gestations after the administration of methotrexate," the decision said.

Despite Prevost's treatment, two pregnancies went to term with fetal anomalies -- anomalies whose cause(s) were not investigated by the College of Physicians and Surgeons.

Now for the (totally predictable) bad news. The fetus freaks are doing wild happy dances in celebration of "botched" abortions resulting in harm.

It's one thing to have an RU486 abortion in a big city. In a remote location, it can carry far greater risks…

Two teensy problems there. 1) The drugs used were NOT RU486. 2) The supposed "remoteness" of Almonte, ON (46 km from downtown Ottawa), had nothing to do with the outcomes.

But for the mis- or uninformed, the sanctioning of this doctor will be seen as a blow to medical abortion in general and the as-yet unapproved (and uninvolved) RU486/mifepristone.

In January 2014, the Canadian Medical Association Journal published a commentary, titled "Medical abortion in Canada: behind the times."

In it, the authors specifically address the difference between the method Prevost -- and all other Canadian practitioners -- have no choice but to use and the "gold standard".

Unfortunately, Canadian women who want a medical abortion (assuming they can find a provider) must resort to a more cumbersome method that uses the cytotoxic drug methotrexate, followed 5–7 days later by misoprostol. Although the methotrexate–misoprostol approach provides a nonsurgical option, it is the second-best method. If allowed to take its course, the regimen is as effective as mifepristone and misoprostol for abortions at up to 7 weeks’ gestation, but its time course is longer and less predictable, with some abortions delayed several weeks after administration of methotrexate. Because methotrexate is teratogenic, the World Health Organization does not recommend it for abortion because of its association with serious deformities in the infant if the abortion fails and the pregnancy continues.

Takes longer, is less predicable, associated with serious deformities if the abortion fails.

Yup. And in the hands of a lesser practitioner, prone to fucked-up outcomes.

On Twitter the other day, I asked Dr. Jen Gunter, Canadian-trained, San Francisco-based OB/GYN, whether such outcomes would be less likely using RU486/mifepristone.

She was a tad busy at the time, dealing with her characterization by Heather Mallick as the dismissible "rural doctor" in The Star's flustercluck over the "dark side" of Gardisil.

1 comment:

It must be uncomfortable to twist one's principals around enough to misrepresent the facts of an event in what is supposed to be a salvo of advocacy. Does SHE think that her readers are stupid or does SHE know it? The denial of scientific and technical advances generally doesn't go well. HER means are as wrong-headed as her (hoped-for) ends.